To the Editor.—
The article "Atypical Contrast Enhancement in Computerized Tomography of Demyelinating Disease" by Dr Marano and colleagues in the Archives (1980;37:523-524) dealing with cranial computed tomography (CT) and multiple sclerosis (MS) raises several issues and questions that deserve further comment.Results of cranial CT-histologic correlation studies have confirmed that there are two types of low-density MS lesions on CT scans: (1) areas of active demyelination1-3 and (2) areas of sclerosis (R. A. Clasen, MD, written communication, May 1979).4 It is conceivable that biopsy specimens of these areas, adjacent to the region of contrast enhancement, may have been obtained in the case reported by Dr Marano and associates.Cranial CT contrast-enhanced MS lesions represent areas of histologically active demyelination5.6 and may result from a loosening of the blood-brain barrier, with resultant extravasation of the iodinated contrast material into the surrounding parenchyma.7 Previously, it was thought that
Aita JF. Atypical Contrast Enhancement in Computed Tomography of Demyelinating Disease. Arch Neurol. 1982;39(3):194–195. doi:10.1001/archneur.1982.00510150064019
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